Pharmacy Administration Week 4 + 5

Question 1

What is the 5 step medication use process

Answer 1

1. Prescribing
2. Transcribing/documenting
3. Dispensing
4. Administering
5. Monitoring/ documenting

Question 2

Define computerized provider order Entry & decision support (CPOE)
Which medication use process is it part of?
Which process does it eliminate?

Answer 2

• Prescribers input orders directly into patient’s EMR
• Clinical Decision supports are alerts for issues such as dosing, renal dysfunction, allergy, duplicate

Eliminates transcription process

Question 3

CPOE
Benefits (4)
Limitations (4)

Answer 3

Benefits
- More timely care
- Easier traceability
- Reduces prescribing & transcribing errors
- Facilitates application of institutional policies (i.e formulary, clinical practice guidelines)

Limitations
- Alert fatigue
- Overreliance on technology
- Increased workload for prescribers
- Risk for new errors as a result of technology

Question 4

What is the increasing use of technology used to ensure distribution is…. (4)

Answer 4

Safe
Frugal
Secure
Timely

Question 5

Which distribution model is safe and secure but not frugal and timely?

Answer 5

Traditional

Question 6

Define wardstock
Features (2)
Advantages (1)
Disadvantages (3)

Answer 6

• Decentralized inventory bulk of common meds
• Rare, expensive medications sent from central pharmacy

Advantages
- timely

Disadvantages
- not safe (expiry dates, storage)
- Resource intensive, increase waste
- Nurses take meds without pharmacist verification

Question 7

Define traditional Drug distribution (3)
Advantages (2)
Disadvantages (2)

Answer 7

• Central drug inventory
• Meds are sent after order is received, pharmacist checks prior to dispensing
• Provides 3-7 days supply

Advantages
- safe
- secure storage

Disadvantages
- Medication waste
- Labour intensive, delayed turnaround time

Question 8

Define Unit dose-centralized (2)
Advantages (3)
Disadvantages (1)

Answer 8

• Pharmacy staff prepare meds for each patient and send it directly to patient’s unit for nurses to administer
• Meds are provided for 24 hours only

Advantages
- safe
- decreased waste
- secure storage

Disadvantages
- Delayed turnaround time

Question 9

Define Unit dose decentralized
Advantages (3)
Disadvantages (1)

Answer 9

Meds are stored in an automated dispensing cabinet on the floor for quick access

Advantages
- Reduces waste
- increase accountability
- Improve security

Disadvantages
- Maintenance cost of technology

Question 10

Define Centralized Intravenous Admixtures (CIVA)
Advantages
Disadvantages

Answer 10

• trained pharmacy techs + pharmacists prepare IVs using aseptic technique
• batch products vs. patient-specific IV

Advantages
- reduces risk of medication erriors
- improves sterility of IV
- Allow for high alert meds to be compounded in central department

Disadvantages
- costs
- delay to administration

Question 11

NAPRA non-hazardous sterile compounding standards requirements (5)

Answer 11

• Immediate use
• Non-hazardous
• Prep does not exceed 3 sterile units
• Do not enter same unit more than 2 times (pokes)
• Aseptic technique (no longer than 1 hour preparation)

Question 12

What are the 6 rights of medication administration

Answer 12

1. Patient
2. Medication
3. Dose
4. Route
5. Time
6. Documentation

Question 13

Define a MAR

Answer 13

Legal record of all medications administered during stay

Question 14

What are example of high alert medications that require independent double checks? (4)

Answer 14

• Insulin
• Heparin
• Opioid infusions
• Chemotherapy

Question 15

Benefits of Barcode Medication administration (3)

Answer 15

• Improved traceability
• Alert if “6 rights” are not achieved
• real-time generation of eMAR documentation

Question 16

Benefits of IV smart infusion pumps

Answer 16

• Improve traceability/reporting
• “Guardrails” alert provider to dose, concentration, rate of infusion issues
• Customizable by clinical area

Question 17

What are the benefits of Unit dose

Answer 17

• Facilitates return to stock
• Improved traceability
• Decreased mental work

Question 18

What are the benefits of dispensing unit

Answer 18

• Improved traceability
• Barcoding decrease
• Efficient restocking
• Limits access
• Override still needed

Question 19

What are strategies we can use to decrease risk within the medication use process (6)

Answer 19

• CPOE
• Decision support
• Unit dose packaging
• Automated dispense cabinet
• Barcode
• eMAR

Question 20

What are strategies we can use within the pharmacy department to decrease risk (3)

Answer 20

• OCP sterile & non-sterile compounding standards
• Standardize & limit concentrations & dose strengths
• ISMP recommendations (look-alike labeling)

Question 21

What are strategies we can use to decrease risk within the organization (5)

Answer 21

• Improved communication
• Independent double-checks for high risk meds
• Medication reconciliation
• Guidelines, clinical pathways, routine order sets for adherence to evidence
• Error reporting systems

Question 22

What is part of the comprehensive direct patient care bundle (CDPBCB)

Answer 22

1. Med rec on admission
2. Pharmaceutical care plan
3. Pharmacists active participation in interprofessional care round
4. patient education during hospital stay and/or discharge
5. Medication reconciliation at discharge

Question 23

How measurement can be used of cpKPIs

Answer 23

Evidence-based extrapolation
Real-life correlation
Heat matrix

Question 24

What is the most to least time spent for pharmacists
Admission med rec
Care plan
Patient education
Discharge med rec
Rounds
DTP resolution
Discharge education

Answer 24

DTP resolution > Care planning > Rounding > Admission MedRec > Patient education > Discharge education = Discharge MedRec

Question 25

What evidence of clinical pharmacist impacts in hospital

Answer 25

1. Reduce preventable ADRs 2. Reduced patient mortality 3. Reduced medication errors 4. Reduced medication costs, total costs, length of stay

Question 26

Define input domain Give example

Answer 26

Systematically identifying, collecting annd evaluating info Eg. clinical trials, clinical practice

Question 27

Define Implementation domain Eg

Answer 27

disseminating and implementation reviewed info at practice level Eg. local clinical, routine order set

Question 28

Define outcome domain eg.

Answer 28

Monitoring the effects of standardized health care Eg patient outcomes,

Question 29

Define clinical practice guidelines Pros Cons

Answer 29

statements that include Pros - effective synthesis of literature - clear communication Cons - bias - plurality - applying to real patients tough

Question 30

Define clinical pathways Benefits?

Answer 30

Structured tool used to apply evidence informed care - Decreased risk for complications - shorten length of stay - lower hospital costs

Question 31

Define routine order sets

Answer 31

Conveniently grouped medical orders to standardize diagnosis Benefits - decreases risk for error and - makes it easy to follow best practices

Question 32

Define drug use evaluation

Answer 32

a performance improvement method that evaluates medication use to improve provide optimal care

Question 33

What are the goals for the DUE process

Answer 33

1. To contribute to positive patient coutcomes through enhanced safety, effective and efficient med use 2. To meet quality standards set by internal and external organizations 3. To enhance medication stewardship

Question 34

What are the 6 drug use evaluation program activites

Answer 34

1. Evaluate medication therapy effectiveness 2. Collaborate with other healthcare professionals 3. Identify where education or interventions are required 4. Monitoring trends and medication costs 5. Maintain external and internal standards 6. Create guidelines for medication use as required

Question 35

What does quality improvement look like in healthcare

Answer 35

1. Timely 2. Efficient 3. Patient-centred 4. Safe 5. Effective

Question 36

quality improvement Initiatives should be: (3)

Answer 36

1. System-based 2. Feasible to implement 3. Have no negative effects on other activities/procedures

Question 37

Define the types of QI initiatives High leverage Medium leverage Low leverage

Answer 37

High - forcing functions and constraints - automation/computerization Medium - simplification - reminders, checklists, double checks Low leverage - rules/policies - education and information

Question 38

Differentiate between change concept and change idea

Answer 38

Change concept - drive brainstorming for new improvement ideas i.e waste Change idea - Formed from change concepts and drive specific actions i.e use substitution, eliminate duplicate entries

Question 39

Differentiate between developmental assessment and regulatory assessment

Answer 39

Developmental Assessment - Dynamic improvement - Accreditiation or certification - Health care professionals - Ethical, commercial motivation Regulatory Assessment - control of practices - Licensure or registration - Government - Legal, mandatory involvement